[Rheumatic diseases in pregnancy]. / Rheumatische Erkrankungen in der Schwangerschaft.

Rheumatic diseases can influence the reproduction, the course of pregnancy and the development of the fetus. The inflammatory rheumatic disease itself can be modulated in its activity in terms of amelioration or exacerbation of the rheumatic symptoms. The associations between rheumatic diseases and pregnancy will be illustrated with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus as examples. Antirheumatic drug therapy during pregnancy and the breast feeding period has to be adapted critically.

Early environmental factors and rheumatoid arthritis.

The precise cause of autoimmune diseases such as rheumatoid arthritis (RA) remains uncertain. In recent years there has been extensive investment in pursuing genes important in RA. However, estimates suggest that the risk of developing RA is at most 50% determined by genes. There has been limited success defining the environmental factors important in developing RA. We hypothesize that this lack of success may be due to a concentration on the time around disease onset. There is evidence of production of the autoantibodies rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP) and increased levels of C-reactive protein (CRP) years before RA becomes clinically apparent. In addition, early life events including intrauterine growth retardation (IUGR) may have long lasting effects on immune function. We review the evidence that the early environment through effects on growth and infectious exposure may influence the likelihood of developing autoimmune diseases such as RA.

[Physiopathology of rheumatoid polyarthritis]. / Physiopathologie de la polyarthrite rhumatoïde.

Rheumatoid arthritis is the most common and most severe form of inflammatory arthritis. Its exact aetiology remains unknown but the combination of various risk factors is involved. Two non mutually exclusive concepts have been suggested: one based on the primary contribution of T cells and the other on that of mesenchymal fibroblastic cells. Both initial pathways lead to a common pathway inducing an intra-articular inflammatory reaction which is non-antigen specific. This process results from the combination of an increased production of destruction-inducing cytokines with a reduced expression of regulatory factors with anti-inflammatory properties. These components represent targets for treatment which are now going through extensive clinical investigation.

Synovial nature of pathologic periarticular structures, including subcutaneous nodules. descent from embryonic arthrogenic fibroblasts: a hypothesis.

In the embryo the periarticular fibroblasts were the producers of the greater part of the joint they surround in later life, as well as of the tendon sheaths and bursae. It is postulated that adult fibroblasts have retained atavistic arthrogenic properties, and may react to traumatizing, inflammatory and oncogenic stimuli by forming periarticular joint-like structures: "arthromas" such as ganglia, meniscal cysts, synovial cysts, synovial sarcoma and subcutaneous nodules. The arthroid nature of these growths manifests itself by the presence of a central cavity, which can be identified as a synovial cavity by histologic, histochemical and electron-microscopic methods. In case of affection of the joint all of these adnexa may be involved. A resemblance of these structures to embryonic joint tissues has been noted for years. The nature of the subcutaneous nodule is discussed at some length. It may contain one or more synovial clefts; synovial elements may be found in its centre by histochemistry and electron-microscopy. Recent and personal findings shed a new light on palisading cells, which may be fibroblasts, having taken up again their embryonic task as synovioblasts. From periarticular fibroblasts thus three kinds of tumors may arise; benign (ganglia, cysts, subcutaneous nodules), malignant (synovial sarcoma) and "semi-malignant" (pannus in rheumatoid arthritis).